Provider Demographics
NPI:1548465081
Name:PARUCHABUTR, KANJANAR (RN)
Entity type:Individual
Prefix:MRS
First Name:KANJANAR
Middle Name:
Last Name:PARUCHABUTR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1612
Mailing Address - Country:US
Mailing Address - Phone:516-294-6968
Mailing Address - Fax:
Practice Address - Street 1:63 WALNUT RD
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:NY
Practice Address - Zip Code:11096-1117
Practice Address - Country:US
Practice Address - Phone:516-371-2635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4849889163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01215329Medicaid